Laparoscopic Gallbladder Removal

Gallbladder removal is one of the most commonly performed surgical procedures in the United States. In the past, a patient who underwent traditional gallbladder surgery could expect significant postoperative pain, a long scar, a hospital stay of 5 to 8 days and a recovery period of 4 to 6 weeks.

Today, more that 90% of all gallbladder surgery is performed laparoscopically, leaving patients with only 4 tiny marks and minimal discomfort. This means most patients go home the same day or the day following surgery and, in many cases, can return to normal activities within a week. These dramatic patient benefits make laparoscopic gallbladder removal the procedure of choice among both surgeons and patients.

What is the gallbladder?

The gallbladder is a pear-shaped sac that rests beneath the right side of the liver. Its main purpose it to collect and concentrate a digestive agent (bile) produced by the liver. Bile is released from the gallbladder and travels through the cystic and common bile ducts (narrow tubular channels) to the small intestine.

What causes gallbladder problems?

Gallbladder problems are usually caused by the presence of gallstones, small hard masses consisting primarily of cholesterol, that form in the gallbladder or in the bile duct. These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting and indigestion.

How are these problems treated?

Some gallstones can be managed with drugs or by making dietary adjustments, such as drastically cutting down on fat intake. However, when severe obstruction of the gallbladder results, removal is the only option. Traditionally, the only way to remove the gallbladder was through a large abdominal incision. Today, with the laparoscopic gallbladder technique, removal can be accomplished through only 4 tiny openings, each 1/4 to 1/2 inch in diameter.

How is laparoscopic gallbladder removal performed?

Laparoscopic gallbladder removal takes place under general anesthesia, so the patient is asleep throughout the procedure. Using a trocar, (a narrow tube-like instrument), the surgeon gains access into the abdomen through the navel. A laparoscope (a tiny telescope) connected to a camera is inserted through the trocar, giving the surgeon a view of the patient’s internal organs on a video monitor.

Three additional trocars are inserted into the abdomen to accommodate special instrumentation. After the cystic artery (blood supply to the gallbladder) and the cystic duct are identified, the surgeon seals them with an instrument called the ENDO CLIP* applier and then cuts the vessels, freeing the gallbladder for removal. Electro-surgical instruments are used to detach the gallbladder from the liver bed, and the bile and stones are suctioned out of the gallbladder, deflating it like a balloon. Using special graspers, the surgeon gently removes the gallbladder through the navel.

Following the procedure, the small incisions are closed with a stitch or two or with surgical tape. Within a few months, the incisions are barely visible. TOP

What are the advantages of laparoscopic gallbladder removal?

By operating through 4 tiny openings instead of the traditional 6- to 9-inch incision, most laparoscopic gallbladder patients have significantly less postoperative pain, heal faster and return to normal activities sooner than patients who have undergone traditional gallbladder surgery.

How long will I be in the hospital?

In most cases, patients leave the hospital the same day or the day after laparoscopic gallbladder surgery. This compares with a 5- to 8-day stay following the traditional procedure.

When can I go back to work?

Most patients can return to work in just 3 to 7 days following the laparoscopic procedure. Patients undergoing the traditional procedure usually cannot resume normal activities for 4 to 6 weeks.

Will I have a large scar?

No. By using laparoscopic techniques, the surgeon can avoid a large incision, leaving the patient with only 4 tiny marks.

Is laparoscopic gallbladder surgery safe?

Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is very low and comparable to the complication rate for traditional gallbladder surgery when performed by a properly trained surgeon. While there are risks associated with any kind of surgery, the vast majority of laparoscopic gallbladder patients experience no complications and quickly return to normal activities.

Since the widespread acceptance of the gallbladder procedure, surgeons have applied the laparoscopic technique to a broad range of surgical procedures, including hernia repair, hysterectomy, appendectomy and lung and bowel surgery.

It is important to remember that before undergoing any type of surgery, whether laparoscopic or traditional, you should ask your surgeon about his or her training and experience. Injury to the bile ducts is a serious and severe injury. In most laparoscopic cholecystectomy operations, if not all, injuries of the bile duct are avoidable. Severe injury to the bile duct may require bile duct reconstruction or other intervention.

Is laparoscopic gallbladder removal right for me?

Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by your personal physician, in consultation with a general surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.